We need to think hard about how we can do things differently to create a sustainable nursing workforce, says Elisabeth Jelfs
The news that at least a third of hospital trusts are actively recruiting nurses from overseas has reignited discussions on the impact of repeated cuts to student nursing numbers since 2008.
Overall, between 2008-9 and 2012-13 places for adult nursing were cut by 18% in England. What is less well-known is that this masks very real regional differences, ranging from cuts of 8% over a five-year period in some regions, to over 30% in others. Put this together with the response to calls for safer staffing and it is no surprise that there are nursing shortages, or that the NHS will be forced to recruit from overseas to fill them. Given that the students recruited in the years of the most stringent cuts are still completing their courses, this is likely to get worse before it gets better.
“We need to be looking ahead and working together across health, social care and higher education to think through the implications of integrated care for education and training”
It is easy to point out that this was the predictable consequence of decisions that prioritised short-term affordability and to call for a re-investment in student nursing places, and it is important to do so. But we also need to think hard about how we could do things differently.
It is in the very nature of service delivery organisations to be geared to a relatively short-time horizon: immediate pressures will almost always take priority. Pre-registration student numbers in nursing, midwifery and the allied health professions are also likely to continue to be seen as an easier target for cuts than investment in medical education, where the time lag for change is greater. Accepting that pressures on service are not going to lessen and the overall budget for education cannot be expected to increase any time soon, how can we reshape the systems we have and move away from cycles of boom and bust?
If we retain a system where numbers of students are managed centrally, there needs to be stronger connections between future service models and workforce planning: creating enough positive incentives to plan for the longer term to act as a counterweight to short-term pressures.
If patient need is best served by community services with “in-reach” into hospital, for example, then student numbers across community nursing and a number of allied health professions will need to grow. But this needs to be planned for sustainably, looking across professions and taking into account the challenges of finding appropriate placements and mentors.
When approximately £1.9bn of the £5bn a year of central funds is spent on postgraduate medical and dental education, this will also mean difficult conversations about relative investment between the professions, let alone across the whole workforce, and whether current patterns are either defensible or financially sustainable.
One of the reasons we need to strengthen the system is because the number of students at pre-registration level is only one part of the jigsaw puzzle: there are many other challenges.
We need to be looking ahead and working together across health, social care and higher education to think through the implications of integrated care for education and training: not only in professionals working across organisational boundaries or in new organisations, but in increasing the partnership with people who need services and their support network that lies at the heart of integrated care.
We need to heed the warning of the dangers of academic isolation highlighted in the Keogh review and to look at how to promote research-rich environments as a norm for nurses, midwives and AHPs. And perhaps above all, we need to ensure that in focusing on getting the future workforce numbers right, we do not do so at the expense of supporting education and training for the existing workforce.
Elisabeth Jelfs is director of policy, Council of Deans of Health